SR0081521 - Laserfiche WebLink

Home Browse Search

ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 709Yj2ti n1�i 3D__ CITY/ZIP I-GD-T O CROSS STREET APN p�� -70 - 6 PARCEL SIZE�J �yj OWNER NAME_ l'JQV< <%! Y�'{W,—t7 1A16— _ _ PHONE OWNER ADDRESS r V DQ(\ 000- CITY/STATE/ZIP `[O�/ q v CONTRACTORS C0A)LT1&"CT;rI 1 S �G1 i�� hC, PHONE _1L�P� 22 ,T— / C CONTRACTOR ADDRESS ��7) ✓hORRS511a C-KEE►_DIL_ STC fl(J CITY/STATE/ZIP 9 ^+41✓ ��__ S_ �._ _ LICENSE /42 J C-36 OTHER NUMBER 92-2:Z,4- EXPIRATION DATE_ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# - LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAI ADDITION ENGINEER DESIGNS /ALTERNATIVE REPLACEMENT _ _ OUT-OF- ERVICE SEPTIC SYSTEM DESTRUCTION - INSTALLATION WILL SERVE: J RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MF _ CAPACITY 4a��E gal #OF COMPARTMENTS GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS A 2y #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH 2 ft LENGTH G ft DEPTH /Z ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH tt DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IVIMUM-48 HOUR ADYANCE NQTICE aEOUIRF.0 EQB 1USPECTIOM PLEASE CALL (2122)953-a9z SIGNED TITLE DATE EST Ijc Q 419 T M NTy T NT rd H D 'PARTMENT SE NLV Application Accepted By Date Area Employee ID#� Final Inspection B Jam« l� Date - `l 2,;, PE IAL PERMIT-Approved b � y �` S r� Y Character of Soil to Depth of 3 Ft:_ ___._ ____________ __. _______ Pit/Sump Soil Character: COMMENTS �i PE SC Received Che Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitte Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18